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This editorial refers to ‘Electrocardiographic anterior T-wave inversion in athletes of different ethnicities: differential diagnosis between athlete’s heart and cardiomyopathy’†, by C. Calore et al . on page 2515. The merits of screening young athletes for cardiovascular abnormalities remain controversial. Corrado et al . provided the most robust contribution to the debate with a study of >62 000 young athletes drawn from nearly 3 million inhabitants in the Italian region of Veneto and included histopathological confirmation of all sudden cardiac death (SCD) cases. Following the implementation of systematic pre-participation screening inclusive of a 12-lead ECG, SCD rates amongst athletes were observed to fall progressively from 4.2 to 0.9 per 100 000 person-years.1 Opponents of screening have noted the uncharacteristically high baseline SCD incidence and have suggested that the subsequent fall to approximate that described in unscreened athletic populations may reflect a statistical ‘regression to the mean’.2 The other major critique of ECG screening is the relatively high number of athletes needing to be excluded from sport potentially to save one life. In the Veneto experience, 9% of athletes were referred for further evaluation and 2% were ultimately excluded from sports participation, equating to ∼60 and 2000 exclusions for each expected case of life-threatening …

T-wave subtleties in screened athletes: sharpening the lead or whittling the pencil away?